Insulin antibodies can prevent insulin from working properly, leading to high blood sugar levels and symptoms of type 1 diabetes. Testing for insulin antibodies can distinguish between type 1 and type 2 diabetes, and some patients with insulin resistance may benefit from steroid treatment or using a different form of insulin.
Insulin is a hormone secreted by pancreatic beta cells in response to an increase in blood glucose or sugar. When large amounts of glucose enter the bloodstream, insulin promotes glucose uptake by the liver, which converts the glucose into its storage form, glycogen. The presence of insulin antibodies in the bloodstream indicates that the body is developing an immune response to external, injected insulin or its own insulin. Insulin antibodies bind to insulin, preventing insulin from interacting with its normal sites of action. As a result, blood and urine glucose levels rise, leading to the classic symptoms of type 1 diabetes mellitus, such as increased thirst, frequent urination, and increased appetite.
Type 1 diabetes occurs when the body attacks its own insulin-producing beta cells in the pancreas. Although type 1 diabetes has been called juvenile diabetes because of its frequent onset in childhood, scientific testing for insulin antibodies led to the discovery of an adult-onset form of type 1 diabetes, called latent autoimmune diabetes in adults (LADA). As many as 20 percent of adult diabetic patients, presumably with type 2 diabetes, may actually have LADA. Doctors can distinguish between these two entities by testing for insulin antibodies, with LADA patients typically testing positive for these antibodies. Type 2 diabetics have high levels of circulating insulin and rarely test positive for insulin antibodies.
Insulin resistance is a condition characterized by a patient’s need for more than 200 units of insulin per day to control their blood sugar levels. This insulin resistance is most often related to the production of circulating immunoglobulin G (IgG) antibodies against insulin in nearly all diabetics who inject insulin. Antibody levels can rise to levels up to 1,000 times normal amounts in nearly 0.1 percent of insulin users. Switching from one form of insulin to another rarely helps, as the antibodies bind strongly to pork, beef and human insulin. Insulin resistance persists for less than a year, with antibody levels gradually falling to normal.
In the United States, there are two possible treatments for insulin antibodies. Steroids, such as prednisone, attenuate insulin resistance, probably by suppressing the immune response. In addition, insulin lispro is resistant to antibody binding due to its altered shape. These two treatments are helpful during the period of insulin insensitivity. Insulin responsiveness can return suddenly, making the possibility of hypoglycemia a serious concern in these patients.
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